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Transition from bottle to breast after NICU - how long?

Hello! I have twin boys, born at 32 weeks (due to IUGR). After 6 weeks in the NICU, we just brought them home last week. During their NICU stay, I tried to breast feed each twin at least once a day. Both would latch and showed signs of continuous improvement, although my larger twin always would stay on longer with a stronger suck. The rest of their feedings they were fed via bottle (after they graduated from the tube). Now that we've been home for about 10 days, I am working so hard to transition both to mostly breast from mostly bottle (they need at least 2 bottles of fortified breast milk a day per my pediatrician). My larger twin is a champ - he will breastfeed for 30 min+... we rented a scale so I know he takes between 70-100 mL's at each feeding. My smaller twin, however, is struggling. My suspicion is that he has nipple confusion after being fed bottles for so long (he takes feedings from the bottle just fine). He will latch on fine, suck about 5-10 times, and then either push off, or purse his lips, as if he was sucking a bottle. After trying for about 10 minutes, he becomes very fussy and frustrated. Occasionally (maybe once a day), he will figure it out and continue sucking for about 10 minutes, but (because I've weighed him) the most he's taken via breast is 25 mL's. So I know he CAN do it.
Yesterday, I tried blocking off 6 hours to only offer the breast. It was incredibly frustrating for us both. He hardly stayed on for longer than 5 minutes any time. After 6 hours, my husband gave him a bottle. I am so nervous to deprive him of food since he is a preemie (5.5 lbs) although he has continues to gain weight every day. Should I stick with this "bootcamp" (not offer bottles & paci's) for a chunk of time every day, or continue to do it for 24 hours, like I've read elsewhere? (I'm so nervous!) Also, my main question, how long does it generally take for a baby to typically transition from bottle to breast after depriving the bottle for a chunk of time? I know all babies are different, but I'm just wondering how long it will generally take - a couple days? A few weeks? (This answer may help me mentally to get through it). I am so determined to get my smaller baby boy to breast, like his brother. I can tell his big brother loves it and is so relaxed during our breastfeeding sessions. I want the sam for him! Also, I can't deal with these night feedings: breastfeeding one baby, then trying to breast feed the other, bottle feed him, THEN pump in the middle of the night. That process takes 2.5 hours and is unsustainable. Also, just to note, I have plenty of milk.. I pump about 1.2 Liters each day. Also, I tried using a nipple shield in the hospital and he never latched at all using it - he latches much better on my bare nipple. Thanks for any advice!!!

Re: Transition from bottle to breast after NICU - how long?

I would not "tough love" or "boot camp" a baby, especially one that size to breast only. He's not nursing well because he is struggling, not because he's trying to be difficult. They are about 39 weeks now? I had 35 wk twins last summer and mine were quite sleepy till around their due date and they struggled with nursing till they were 10 weeks old/ 45 weeks gestation. One thing I did and still do, though, is I got rid of the bottles and use a lactation aid to supplement at breast. http://www.breastfeedinginc.ca/conte...agename=doc-LA is good info on them. It is hard to pump, bottle and nurse twins. It's really hard! Do you have anyone who can bottle feed your little guy during the night? Can you nurse in bed to get a little more rest? With twins there is really no way around needing help - I hope you have people who can do all the cooking, laundry and cleaning for honestly a few months.

Another thought on the boot camp. I'm not a fan at all, because I tried it with my 4 yr old daughter on the advice of our IBCLC and she lost wt and it was terribly traumatic for both of us even though she was 2 months old. But if you do it, our neonatologist said try when they're 9 lbs. Have you seen an IBCLC since coming home? Your big twin sounds like he's doing great and your supply is great so I hope that is encouraging to you. Hang in there.. Twins are a lot of work. Mine are almost 6 mos now and I'm not as exhausted as I was but they're still tiring and extra helping hands really do help so I hope you have good support.

Re: Transition from bottle to breast after NICU - how long?

Oh, and one of my friends had twins with IUGR and her little guy took 4.5 mos to get fully on breast. It was a ton of work and so exhausting but she did make it through and has nursed them almost 2 yrs now.

Re: Transition from bottle to breast after NICU - how long?

One of my twins was IUGR and honestly, she just never took to the breast. She would nurse in the NICU once a day and then at home but when I saw an IBCLC she said she wasn't transferring milk and she would just get so tired she wouldn't eat. So I just pumped for her. I decided I'd rather she eat the milk from the bottle and grow rather than struggle with her and have her be too tired to feed. The first 3 months were so tiring because I would breast feed one twin and then pump afterwards but it was worth it and now they're almost 10 months old!

Re: Transition from bottle to breast after NICU - how long?

My b/g twins are 3.5-years now and my daughter really struggled. Before giving birth I had been determined to breastfeed exclusively for 6 months. We were not in the NICU, but my little girl just always had a tough time nursing at first. We just couldn't get the hang of it together. She just couldn't quite "get it" if that makes sense. She couldn't transfer milk well and every time she tried to latch she would leave me bleeding and crying. At 8 weeks I made the heart-breaking (for me) decision to just pump for her because in the end it was more important to get nutrients into her than for her to be at the breast. At that time, I made sure to feed each baby individually (very time consuming…….) and then pump. If I had hubby at home or someone else I loved around, I would ask them to give my daughter a bottle while I nursed my son so that I could try to get a bit more rest.

At this age and weight, I think your son is too little to push that hard. He's too little to make all of the connections that he needs and won't respond when you essentially give him an ultimatum of nurse or you don't get fed. I would recommend doing what you need to do right now to make sure that he gets the calories and nutrition that he needs right now in whatever way you have to. I know how frustrating it can be, especially when you have your heart set on doing something else. Pump when you can, attempt to nurse when you can, and do what you need to do.

I will also say that if you do go to exclusively pumping and using a bottle now that it is possible to get back to the breast when the baby is a bit older. For my daughter it took until she was 5 months old. At 5 months I decided to give her another try and after some careful work and learning by both of us, she began nursing exclusively and we never looked back! Though I did continue pumping for awhile longer because I wanted to build up a stash "just in case." If you decide that you want to try again later on, absolutely go for it!

Whatever you decide to do, good luck!

Mom to amazing twins!
DD nursed for 3y5m, DS still occasionally stops by for a snack